Laserfiche WebLink
BOARD OF PUBLIC WORKS <br />AGENDA ITEM REVIEW REQUEST FORM <br />Date November 5, 2019 <br />Name Andrew Netter............ <br />Department DCI <br />Division/Bureau Planning <br />BPW Date 11/12/2019 Phone Extension 5931 <br />wwwwwwwww!�w �^�r.+ror+ romuvwa,��,��w,an.;�miHiHi��HiHiHiMmAi�r�iHiHi�i�uninininininimimm.;�sa�u,��,uxemwrm�,rta�nai.®�,�m. _.,�,.,.�� wrmww "mwm;miv� <br />,—,,,,,,,,,,,—,,,,,Required Prior to Submittal to Board <br />Legal [;I Attorney Name: Clara McDaniels <br />Controller ❑ Controller review is required for all Contracts $5,000.00 or more and <br />greater than one year in length per the City Purchasing Policy <br />Purchasing ❑ <br />Check the <br />❑ AgreementAmendment <br />Professional Services <br />Bid Opening <br />Quote Opening <br />Change Order No. <br />El Ease/Encroach. <br />M Other: Personal Mrooerty <br />Company or Vendor Name <br />A�ropriate Item Type - Require <br />❑ Contract <br />0' Resolution <br />❑ Bid Award <br />❑ Quote Award <br />F] C/O & PCA No. <br />❑ Traffic Control: <br />Transfer Agreement <br />Required Information <br />New Vendor <br />MBE/WBE Contractor <br />MBE/WBE Contractor Requested <br />Project Name <br />Project Number <br />Funding Source <br />Account No. <br />Amount <br />Terms of Contract <br />Unitv of Michiana. Inc. <br />for All Submissions <br />� Proposal <br />Req. to Advertise <br />E] PCA <br />LJ Yes L� No <br />Purchasin <br />MBE ❑_ WBE <br />❑ No ❑ Yes Name of Co <br />Personal Propertv Transfer <br />Addendum <br />❑ Title Sheet <br />If Yes, Approved by <br />reement. <br />Purpose/Description The City wishes to transfer 1 modular building to Unity of <br />p,,,,;,,a non. -_profit.. <br />is iana rsuant I.C.36-1-11-1 b 7 Transfer to <br />❑] Required Contractor's Certification Forms Attached (Non - <br />Collusion, Non -Discrimination, Non -Debarment, E-Verify, Iran, etc.) <br />......._fR Wired For Change Orders'Only <br />Amount of Increase $ ............. <br />Decrease $ <br />Previous Amount $ <br />- -� .----------- <br />...............__ <br />Current Percent of Change... % <br />New Amount $ <br />Total Percent of C gQg.: % <br />Dispersal After <br />Copy <br />Original <br />® <br />[�' Andrew Netter <br />